Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Radiation Oncology, Radiotherapy & Nuclear Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Pain Med. 2017 Feb 1;18(2):363-373. doi: 10.1093/pm/pnw143.
The goal of this study was to elucidate the attitudes, beliefs, and barriers interfering with cancer pain management, the degree of barrier interference with trainees’ care of patients, and the relationships among prohibitive factors to pain management for physicians in a low–middle-income countries (LMICs) vs high-income countries (HICs).
A multi-institutional cross-sectional survey of physicians in specialties with a focus in pain management training was performed. All surveys were completed anonymously from July 1, 2015, to November 30, 2015.
One hundred and twenty physicians participated in the survey.
Surveys were based on prior questionnaires published in the literature. Descriptive statistics were calculated, and chi-square (ℵ2) analysis, Fisher’s exact test, and Spearman rank correlation analyses were performed.
Compared with their peers in HICs, physicians in LMICs reported less experience with cancer pain management despite seeing more cancer patients with advanced disease (41% vs 15.2%, p < 0.05). Some barriers were common to both environments, but a few were unique to each setting. Organized by percentage of severity of interference, cultural values/beliefs about pain (84% vs 76%) and lack of training and expertise (87% vs 78%) were significantly more prohibitive for physicians in LMICs than those in HICs; p < 0.05.
There are significant differences in perceived barriers and degree of prohibitive factors to cancer pain management among trainee physicians in low- vs high-resource environments. Understanding these differences may spur further collaboration in the design of contextually relevant solutions, which could potentially help improve the adequacy of cancer pain management
本研究旨在阐明癌症疼痛管理中存在的态度、信念和障碍，以及这些障碍对低中等收入国家（LMICs）和高收入国家（HICs）医生患者护理的干扰程度，以及这些障碍与医生疼痛管理之间的关系。
对专注于疼痛管理培训的专业医生进行了一项多机构横断面调查。所有调查均于 2015 年 7 月 1 日至 11 月 30 日匿名完成。
共有 120 名医生参与了调查。
调查基于文献中发表的先前问卷。计算了描述性统计数据，并进行了卡方（ℵ2）分析、Fisher 确切检验和 Spearman 秩相关分析。
与 HICs 的同行相比，尽管看到更多患有晚期疾病的癌症患者，但 LMICs 的医生在癌症疼痛管理方面的经验较少（41%比 15.2%，p<0.05）。有些障碍在两种环境中都很常见，但也有一些是每个环境特有的。按严重程度干扰的百分比排列，文化价值观/对疼痛的信念（84%比 76%）和缺乏培训和专业知识（87%比 78%）对 LMICs 的医生来说比 HICs 的医生更具抑制性；p<0.05。
在资源环境高低不同的受训医生中，对癌症疼痛管理的感知障碍和抑制因素的严重程度存在显著差异。了解这些差异可能会进一步促进在设计具有上下文相关性的解决方案方面的合作，这可能有助于提高癌症疼痛管理的充分性。
